The need for networking and the challenges posed by diversity within the vast Arab world are two of the issues that emerged prominently from the Boosting research for health in the new Arab world meeting in Bellagio, north Italy which ended on Friday (1 March).

No one doubts that much cooperation and coordination will be necessary in order to tackle the research for health demand, but it is honestly difficult to see how virtually failed states such as Somalia, economically advanced realities like the Gulf States, and the Maghreb and Mashriq countries with their variable income levels, can be brought together to put forward a unified vision for public health in the region.

Up to now, there has been very limited dialogue among these countries, and not only regarding research- or science-related issues (the overall value of trade exchange between Arab countries, for example, is low). However, those involved in the health research agenda are positive that diversity in the Arab world, if wisely used, can actually benefit the requested change, as delegates present at the Bellagio meeting told SciDev.Net.

“Diversity should be perceived as an important factor for complementarity instead of a reason for division,” said Ziad Abdel Samad, Executive Director of the Arab NGO Network for Development in Beirut, Lebanon. “There is the necessity to create processes at various levels that must include academia and research. I’m aware of many existing initiatives among different universities and research centers focusing on health from different countries of the region.”

Samer Jabbour, from the Faculty of Health Sciences of the AmericanUniversity of Beirut, Lebanon, said: “All countries have a stake in cooperation as it will promote development and contribute to stability and legitimacy. Regional cooperation based on solidarity is simply the right thing to do. But we need to push, and from the bottom up, for this to happen in light of a prior history of poor functioning of formal regional platforms for common work. This is the task ahead of us.”

The role of the Gulf States might play in the effort is a matter of particular importance, given both their economic prominence and the considerable resources some of them, notably Qatar, dedicate to R&D.

Hanan Abdul Rahim, at QatarUniversity in Doha, Qatar, said: “There is a great interest in the Gulf in developing R&D systems. For example, Qatar partners with well known international universities in specific fields, such as medicine, engineering, and computer science, and links to a number of international research initiatives.”

“At the same time, the Qatar National Research Fund presents an opportunity for research collaborations with all parts of the world. Regional and international collaborations are not mutually exclusive. One does not have to preclude the other,” said Rahim.

But some believe that, in order to lead the research-for-health revolution in the new Arab world, the Gulf States must genuinely believe in their spearheading function while seriously reconsidering their attitude towards neighbours and potential partners.

“Regarding the Gulf states, many in the region want to see them play a greater role in promoting health and development,” said Jabbour. “This is another subject for advocacy for those interested in promoting research for health and development.”

But Abdel Samad said that “Gulf countries are supporting other Arab and Islamic countries; they are even considered among the largest donors worldwide. However, most of their donations are dedicated to charity and faith based initiatives. Few of these donations are directed to fund development programs and research projects.”

There is a lack of structured and transparent process of selecting partners and programs, and the way support is channelled is often conditioned by subjective choices, which highly affects the impact of allocated funds, argued Abdel Samad.

“This is a source of frustration which is leading people in the Arab world to rather address foreign donors that have their own requirements and conditions,” said Abdel Samad. “The objective is to advocate the Arab donors in order to motivate them to change this perception, and to create a properly transparent system, participatory methodologies and efficient strategies for implementation.”

More than a third of Brazilian households are in a “food insecure situation”, meaning there isn’t enough food to feed family members and food quality is too poor to ensure healthy life, according to the Brazilian Institute of Geography and Statistics (IBGE).

This issue was the subject of a press conference discussion between two Brazilian scientists, Elibio Rech and Protásio Lemos da Luz, at the IAP conference of science academies in Rio de Janeiro this week (25 February).

Rech, a molecular biologist at the Brazilian Agricultural Research Corporation (Embrapa) and a member of the Brazilian Academy of Sciences, defended a new metric for inequity and unsustainability which analyses components including human health (nutrient deficiencies, exposure to chemicals); social and economic well-being, including the percentage of children in school and the use of ecological knowledge; environmental sustainability (carbon dioxide emissions, energy management, nutrients and water efficiency); available technologies; economic prosperity (employment, price fluctuations etc); and food security (nourishment and food access).

“The equation is simple,” Rech said. “The problem is that there’s no political will to make it operational for transformation. Social issues can be changed with public policies, but the existing policies are fragile, because they focus only on one or two components. To provide water or technology is not enough. The sum of the components is needed.”

He added that very few changes have been made since 1995, when the first agricultural census was taken in the country.

In Rech’s opinion, the main component in the equation is child education. “It’s unacceptable to have children working in the fields,” he said. “They should be at school, but this won’t happen if the father doesn’t have credit access, tractors or animals for ploughing.”

Another aspect discussed at the press conference was the incidence of cardiovascular disease —currently the leading cause of global mortality — and its relation to the excessive consumption of fat and sodium (salt).

Cardiologist Protásio Lemos da Luz, from São Paulo University, explained that the risk factors are the same both in rich and poor countries.

“It’s a global epidemic,” he said. “One in four people in world are obese. Overweight, smoking and excessive salt consumption are the main causes [of cardiovascular disease] in poor countries; in rich countries, there is less hypertension and smoking, but carbohydrate consumption is higher. Even children and adolescents are obese,” he said.

The treatment for this disease involves medication and lifestyle changes, he added.

“Changing lifestyles is very difficult, but in Finland, reductions in butter consumption decreased heart diseases by 85 per cent. Reducing salt consumption in Brazil would represent a great economy in healthcare, Luz said.

He added that because children can influence their parents and the family in nutritional education, the policies should focus on them.

Three of Brazil’s most prominent scientists, Carlos Nobre, Luiz Pinguelli Rosa and Jacob Palis, came together this week to stress the importance of cutting greenhouse gas emissions now, to help moderate the planet’s rising temperature and reduce the impact of climate change.

The three scientists were reunited during a press conference at the annual conference of science academies’ network, IAP — Grand Challenges and Integrated Innovations: Science for Poverty Eradication and Sustainable Development — held in Rio de Janeiro this week (24-26 February).

Global conventions on the interface between environmental quality and human development are not advancing as they should, according to Nobre, secretary of the Policies and Programs in Research and Development secretariat at Brazil’s Ministry of Science, Technology and Innovation.

Climate issues are of particular concern, he said, because studies indicate alarming risks if greenhouse gas emissions are not reduced in order to balance the planet’s rising temperature.

“Consequences will be very severe,” he said. “Adaptation is already a necessity. To have a lenient attitude with emissions rising, and to expect that it will be possible to reduce or adapt in the future, is not responsible.”

Nobre — who is also chair of the International Geosphere-Biosphere Programme’s scientific committee and executive secretary of the Brazilian Research Network on Global Climate Change Science — explained that while the planetary system is naturally instable, scientific evidence of humanity’s contribution to climate change is overwhelming.”Earth climate is changing 50 to 100 times quicker than in the period between the end of the last glaciation 20,000 years ago,” he said. “We have never had such a rapid change. And the best explanation, dominant among scientists, for the rising temperature, is the greenhouse gases we are emitting.”

He added that as the stratosphere is getting colder, and the ‘sun-getting-stronger’ theory advocated by some climate sceptics doesn’t fit the evidence.

Nobre also said he believes the reports produced by the Intergovernmental Panel on Climate Change (IPCC) have a great impact, because they point to the urgency with which countries need to act and expose scientists’ worries about climate change.

He did, however, admit that scientists can also make mistakes. Since the 2007 IPCC report, which have overestimated the speed at which glaciers were melting (a mistake which was later corrected), the organisation had become much more rigorous regarding information, he said.

The fifth IPCC report is currently being compiled.

Knowledge has advanced almost 50 per cent in seven years and results are more solid, in spite of uncertainties and intrinsic instabilities, Nobre said.

Jacob Palis, president of the Brazilian Academy of Sciences, explained that every prediction system carries some uncertainty, an idea which he said people often found difficult to grasp.

“It’s a complex system, and that’s why we are talking about probability,” he said. “But it doesn’t hinder us of from doing the best work possible.”

Luiz Pinguelli Rosa, a professor of nuclear physics at the Federal University of Rio de Janeiro and executive secretary of the Brazilian Forum on Climate Change, said: “We cannot be optimistic.”

He said worldwide discussions were “stuck in a rut,” as the Rio+20 summit last year, when climate matters were barely discussed, had affirmed.

Two of the world’s biggest challenges are waste management and energy production. Most of the trash from the world’s cities ends up in landfills, with several negative impacts to the environment.

Meanwhile, our demand for energy is rising, following the industrialisation of emergent markets and the rapid population growth. In order to discuss solutions to the world’s energy problems, participants of IAP’s conference in Rio met at the Challenge Lab ‘Towards a sustainable energy future’, on the second day of the event.

Sherien Elagroudy, assistant professor of Environmental Engineering at Ain Shams University in Cairo, Egypt, talked about the challenge of using technologies to convert waste into energy.

Elagroudy shared some good news she received that day: her team had secured a US$1.8 million grant to establish the first Solid Waste Management Centre of Excellence in Egypt, with the main goal of increasing the efficiency of waste-to-energy technologies. Municipal solid waste could be turned into electricity and fuel.

The project is a partnership between Egyptian research institutes, industries and a consultancy. The Centre will focus on three objectives: to come up with innovative ideas in the field of waste management, including waste collection, transfer, treatment and disposal; to educate managers, students, and people who work in the field; and to create public awareness of the value of waste.

The Centre will consist of two labs at the Ain Shams University and one lab at the University of Cairo.

“We also signed endorsement letters with ten international institutes to collaborate with us,” says Elagroudy, who has recently won the best young scientist award from her University, and has been selected as a Young Scientist at the World Economic Forum 2012.

If the team wants to scale up their technology, they will be able to do it, because of the partnership with one industry that manages Cairo’s municipal solid waste. “We are very much looking forward to it,” commemorates Elagroudy.

Women in developing countries are at a greater risk of having pregnancy related complications that lead to death. Every year, half a million women die from those complications.

“That means one woman dying every minute,” says Patricia Garcia, president of the Latin American Association to Control STI (ALACITS) and a recognised leader in global health, during IAP’s conference in Rio de Janeiro. “In developing countries, the risk of dying is 100 times higher, compared to rich countries,” she adds.

She drew attention to the topic of maternal and child health during the Challenge Lab ‘Improving global health’, which took place on the second day of the conference. Most pregnancy related deaths can be prevented with good antenatal care, which includes a package of laboratory tests to detect diseases and complications like HIV, syphilis and eclampsia – the leading cause of maternal and fetal mortality.

“Unfortunately, in developing countries we lack labs, trained persons and tests,” said Garcia. She presented the challenge of how to improve maternal health and child survival with appropriate diagnostic technology.

One of the tools that can help tackling this problem is point-of-care testing. These are diagnostic tests that can be made by a care provider at the site of patient care, and allow the care team to have the results in a timely manner, improving the provision of services on maternal and child health.

Garcia considers that the biggest problem today is the lack of a single test that can diagnose eclampsia early enough, and believes that point of care tests can be a solution. These should be easy to use, accessible, reliable, environmentally friendly and ideally in one package.

In order to have them available to diagnose the top causes of maternal health problems, a multidisciplinary effort is needed. In the group discussion, participants talked about the need of different actors coming together to solve this problem: people working in labs, social workers, policymakers, and also engineers and designers, who could design a test that’s easy to use and interpret, including by people who may not be doctors or may be illiterate.

Participants also stressed the need of educating women, healthcare providers, researchers and funders on the issue.

Working groups gathered to think on country-specific needs for health research system strengthening, focusing on three main aspects: regional strategy and plan of action, engaging partners and building networks, funding perspectives.

The fund-raising problem is of course a crucial one, so a large part of the broader discussion that followed was devoted to explore possible avenues to get potential donors and financing bodies involved. Since the all initiative of strengthening health research in the Arab world is brand new, and the group of people that is coordinating the effort met here for the first time, one should not be surprised to know that only vaguely shaped plans were brought to the table so far. However, good, solid common ground was found to build on by selecting shared pointers for future action.

First, delegates agreed on the need for coming out with a ‘Big Idea’ about boosting health research as a driver of improvement of public health, advancement of fairness of health and equity, and socio-economic development in the region.

This should be something that captures imagination of donors and funding bodies, while being amenable to be efficiently communicated and appealing to politicians and the lay public as well.

“Something exciting is needed, but I still don’t see it here. This is necessary not only, or primarily, to allure donors, but to have a sharp vision of the common goal to achieve,” said Ibrahim Daibes, from the Canada-based aid agency International Development Research Centre, confirming that work has to be done in this direction.

Another consultation, opened to a larger panel of researchers, policymakers and stakeholders, will be held in a 6-months time frame to develop the ‘Big Idea’ concept further.

It was also noted that for the change to become structural and to impact substantially on health and related societal issues, donors will not be enough, but rather national governments need to be convinced to allocate appropriate resources to R&D in the health sector in their budget over a long period of time.

This – in a region where health and R&D expenditure is (with a few exceptions) relatively low (but that, on the other side, boasts the highest ratio of military expenditures as a percentage of GDP in the world) – is not going to be easy, as those around the table here in Bellagio are well aware.

Certainly, a carefully planned communication strategy will be key to the project, both to persuade international funding agencies to take the risk of investing in research in countries in conflict and transition and to raise advocacy at the national and regional level. “We have to speak clear, so to be sure that people don’t think we are asking for money just to fund our own research or academic institutions,” said Hoda Rashad, from the American University in Cairo, Egypt.

Gregory Weiss, from the Global Young Academy, proposed a development of an “internet-based marketplace of ideas and opportunities” at the 7th IAP Conference on Grand Challenges and Integrated Innovations: Science for Poverty Eradication and Sustainable Development, held in Rio de Janeiro this week (24-26 February).

The website would connect scientists, funders, national academies and the wider society to ideas, success stories and funding opportunities focused on accelerating sustainable approaches to addressing Grand Challenges associated with poverty.

According to Weiss, the project would require a very modest investment in support to curate and support a website, yet could deliver large gains in efficiency by empowering scientists and national academies to connect and leverage new opportunities for collaboration and broader adoption of successful practices.

The proposed marketplace would address three user communities – funders, scientists and society.